Abstract Background Systemic sclerosis (SSc) is an autoimmune disease associated with prognostically significant cardiac complications, such as pulmonary hypertension. The recently defined primary heart involvement (SSc- pHI) comprises cardiac abnormalities that are attributable to SSc rather than other causes. Furthermore, atherosclerosis, ischaemic heart disease and hypertension, which may have a higher incidence in this population are considered non-SSc specific cardiac complications. SSc-pHI is often subclinical, but may be present at the time of disease onset. Tissue Doppler Imaging (TDI) speckle-tracking (STE) have proven valuable in identifying abnormalities in affected individuals. Purpose This study aimed to identify early changes in the myocardial mechanics through TDI, STE and myocardial work parameters in recently-diagnosed patients with SSc. We aimed to minimize the impact of other cardiovascular risk factors (CVRF) through one-to-one matching. Methods 23 consecutive asymptomatic patients recently diagnosed with SSc were recruited. 3 patients were excluded as they had at least intermediate echocardiographic probability of PH and required further investigations. 20 SSc patients with low echocardiographic probability of PH were included. 20 controls were selected after 1-to-1 matching. The matching was done for age, sex, arterial hypertension, dyslipidaemia and smoking. Individuals with symptoms, history, or evidence of significant coronary artery disease were excluded (Figure 1). The images were analyzed by one operator using a dedicated post-processing software to avoid interobserver variability. Results The mean duration from diagnosis to echocardiogram was 1.9 years. There were no significant differences in the left ventricular (LV) and right ventricular (RV) 2D (LVEF, TAPSE, RV FAC), TDI (septal and lateral LV wall S’ wave velocities and RV free wall S’wave velocity) and STE (GLS, RV FWS, RV GS) systolic parameters (Table 1). However, global work efficiency (GWE) was significantly impaired in SSc patients (93.2±3.6% vs 95.3±1.6%; p=0.026) with a higher global wasted work (GWW) (140.6±85.8mmHg% vs 91.9±34.9mmHg%; p=0.024). The systolic pulmonary artery pressures (sPAP, 31.1±5.1mmHg vs 24.9±4.6mmHg; p0.001) and tricuspid regurgitation (TR) velocities were higher in patients compared to controls (2.4±0.3m/s vs 2.1±0.3m/s; p=0.005). The TAPSE/sPAP ratio was lower in patients (0.7 ± 0.1mm/mmHg vs. 0.9 ±0.2mm/mmHg; p=0.002). The diastolic function did not differ significantly between groups according to the E/A or E/E’ ratio. The left and right atria showed similar indexed volumes. Accordingly, there were no significant differences in the atrial strain parameters. Conclusions Impaired left and right ventriculo-arterial coupling, as evidenced by GWW, GWE and TAPSE/sPAP ratio, is present early after diagnosis and may be a manifestation of SSc-pHI.Figure 1 Table 1
Andrei et al. (Sat,) studied this question.